Where is Covid-19 deadlier than Influenza-Pneumonia?

Covid-19 has been with us for more than eight months. That is, if we are to count from 17 November 2019 when a 55-year-old individual from Hubei province in China may have been the first person to have contracted COVID-19. However, this “patient zero” was never confirmed. Since then, it has spread out across the globe. Covid-19 is not the biggest pandemic since the Spanish Flu of 1918. The 1968-70 H3N2 Hong Kong flu killed 1 to 4 million in 1968-70. The 2009 H1N1 swine flu pandemic killed 155,000 to 575,000 by various estimates. These pandemics are lost to public memory. The difference between 2009 swine flu and Covid-19 is the hysteria whipped up by the media and especially, the new social media. Governments adopted extreme measures. These have turned out to be ineffective in controlling the spread of the virus but has caused historic levels of economic devastation. The Spanish flu lasted about 15 months, over several phases, from spring 1918 to early summer 1919, infecting about a third of the world's population at that time. We can safely say that for many countries, Phase I may be nearly over, and it is not known whether a Phase II may be looming large. However, there are significant regions of the globe where Covid-19 infections and deaths have been a fraction (from a hundredth to a tenth) of that in Western Europe and North America (WE & NA) where it has been most devastating.

It has been famously said that the coronavirus sees no religion, race, colour, caste or creed before striking. However, the evidence we present here shows that coronavirus does seem to discriminate between regions. Indeed, there are orders of magnitude variation.

In many ways, Covid-19 is like the flu but in many ways it is not. It is far more infectious and has a higher case to fatality rate. In the United States, the number of COVID-19 deaths till mid-July was three to four times greater than the annual average number of flu-related deaths over the past decade. Yet in many countries, the number of fatalities from Covid-19 are so far only a fraction of that from Influenza and Pneumonia in a year. Most of the reported Covid-19 deaths are from the world's richest countries which typically have the lowest Influenza-Pneumonia mortality rates. 1 However, counter-intuitively, there is an inverse relationship between the number of deaths per capita in each country due to Influenza-Pneumonia and the cumulative progress of deaths per capita in each country from Covid-19. That is, countries which have high mortality rates due to Influenza- Pneumonia have been registering much lower Covid-19 mortality rates (a tenth to a hundredth) than countries where influenza-pneumonia mortality is low, perhaps due to extensive vaccination coverage and better health care facilities (physicians, hospital beds, etc.) It will be interesting to see where Covid-19 is deadlier than Influenza-Pneumonia.

Here we collect data for 177 countries for which Covid-19 and well as Influenza-Pneumonia mortality rates were available: https://.../cause-of-death/influenza-pneumonia/by-country/

We clustered the 177 countries into nine major sub-continental or regional groups:

Africa – 53 countries

Asia -non-Sinosphere – 16 countries

Asia-Sinosphere – 11 countries

Caribbean – 8 countries

Eastern Europe (EE) – 24 countries

Latin & South America (LA) – 23 countries

Middle East – 14 countries

Oceania – 6 countries

Western Europe & North America (WE & NA) – 22 countries

The East-Asian (Sinosphere) and Buddhist countries of South-East Asia have had remarkably low mortalities and have been clubbed together as a cluster of 11 countries (China, Japan, Cambodia, South Korea, Laos, Myanmar, Mongolia, North Korea, Singapore, Thailand and Viet Nam.) The remaining 16 countries from Asia have been kept together as a separate cluster.

Fig. 1. Scatter plot from 177 countries clustered into nine main sub-continental or regional groups. Influenza-pneumonia deaths per year per million is shown on the horizontal or x-axis and Covid-19 deaths per million on 19/07/2020 on the vertical y-axis. Note that the graph uses logarithmic scales. Also shown are lines indicating the multiplier ratios. This varies from 0 to 10x, but as zero values cannot be displayed on log-log scales, the smallest ratio seen is a thousandth!

Countries with zero deaths cannot be displayed on a log- log plot. Influenza-pneumonia deaths per year per million is shown on the horizontal or x-axis and Covid-19 deaths per million on 19/07/2020 on the vertical y-axis. Also shown are lines indicating the multiplier ratios. On a log-log plot these appear as parallel lines. This varies from 0 to 10x, but as zero values cannot be displayed on log-log scales, the smallest ratio seen is a thousandth!

There is a great deal of noise in Fig. 1. To see an overall picture, for each of these regions, the two indicators (Flu-pneumonia deaths per year per million on the horizontal or x-axis and Covid-19 deaths per million on 19/07/2020 on the vertical y-axis) were averaged out and the scatter plot of nine data points is shown in Fig. 2, again using logarithmic scales. Between Europe and North America, and Africa, there is a four hundred-fold difference. Between Europe and North America, and Asia-S, there is a nearly two hundred-fold difference. Between Europe and North America, and Oceania or the Caribbean, there is a hundred-fold difference. Eastern Europe, Latin and South America and the Middle East are nicely ensconced within these regions. The rest of Asia follows with lower multiplier ratios.

At this stage, we can only speculate on the reasons for the regional variation. In each region, there are outlier countries – it is not evident that they are defined by climatic zoning. Europe and North America, apart from accounting for most of the richest countries on the globe, are also regions where extensive influenza vaccination is practised. At this stage, all we can infer is that other confounding or random factors or events affect the country Covid-19 toll. We can count population age structure, health care facilities, immuno-suppression, etc. all of which range significantly from rich country to poor country.

Fig. 2. Scatter plot for the mean values from nine main sub-continental or regional groups. Influenza- pneumonia deaths per year per million is shown on the horizontal or x-axis and Covid-19 deaths per million on 19/07/2020 on the vertical y-axis. Note that the graph uses logarithmic scales. Also shown are lines indicating the multiplier ratios. This varies from 0.01x to 3x.

AJIT HARIDAS AND GANGAN PRATHAP